REV-16-2423'�LF U1�o- 2423
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BUILDING
PERMIT APPLICATION
Miami Shores Village _.
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Building Department
4AUG'���
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 5
FBC 20/4
Master Permit No. E J U - 2.y Z
Sub Permit No.
K] BUILDING ELECTRIC ❑ ROOFING
\` PLUMBING �MECHANICAL ❑ PUBLIC WORKS
JOB ADDRESS: 4 z T Ij r%' I U� y1�
❑ REVISION ❑ EXTENSION [—]RENEWAL
CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
tQk41 S /J612,e5( r1.
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: // 3 Z a & "d 17 -0 50 Is the Building Historically Designated: Yes NO ✓
Occupancy Type: 14 fv 5. Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Al A121't' // Al OJA5 # Phone#: I - 8 S -7 S 2 0 3? "3
Address: 4 2 ¢ /NL / o
City: /,4 l &AM State:
Tenant/Lessee Name:
Email:
CONTRACTOR: Company Name: l a/1"f;e- NS T?014At Phone#: z e
Address: G 1 Qc `G
City: J-� l b*4 State: /= L Zip: 3311
Qualifier Name: ��/lCL n '"� ' i'r kj d Phone#: "L3 2 0
State Certificationn,or Registration #: l� ci v 6 Certificate of Competency #: l 3 a 0'0 30
t4�eDESIGNER: Arch itect/Engi R�aJr6OkS'G"Sn#��'�' j
Address: City: State: Zip:
Value of Work.for this Permit: $ Square/Lineao&— &e of Work: 11�) h
Type of Work: 1z Addition ❑ Alteration ❑ New lace ❑ Demolition
Description of Work:
l '/2 0 ATNIS,
Specify color of color thru tile: TC-
Submittal Fee $ 2(7J - O�3 Permit Fee $ �DJ 40 CCF $ CO/CC $ Q A -
Scanning Fee $ / �i Radon Fee $ DBPR $ =� 2 ` Notary $ 7�; - OD
Technology Fee $ Training/Education Fee $ � Double Fee $ 1,-940
Structural Reviews $(00. Ck' Bond
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
WE
Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith thatn� 6,py of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is su �'tI-"attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspect/N.} hich occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will n0 fi . approved and a reinspection fee will be charged.
Signature -4Mal. VVx4l
OWNER or AGENT
The foregoing instrument was acknowledged before me this
� ' N
day of 40 4- 20 / v by
AIX1.1 d 61 /v,d .sJA who is personally known to
me or who has produced
as
identification and who did take an oath.
NOTARY PUBLIC: 5%h,
406
Sign:
Print: NR LQF fWAMPcou.
Seal
W COMMISSIOM i EE 831785
EXPIRES: January 14, 2017
Bonded Ttru Notary Pu* umvmtin
#######################
APPROVED BY
(Revised02/24/2014)
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Plans Examiner
Signature l
CONTRACTOR
The foregoing instrument was acknowledged before me this
3 day ci&GV S7 20 by
�l GIJ LU(S 14Q, who is personally known to
me or who has producec[T} `�,'O k-FP_ �-- IQ)Ek, has
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal:
Structural Review
ro W P.& Notary Public State of FlaridA
Sindia Alvarez
ce My C.ommisaton FF 156750
OFo'F Expires 00103,1018
i, Zoning
Clerk